title: Conservative management of an infected laparoscopic hernia mesh: A case study.
abstract: BACKGROUND
  A dreaded complication of laparoscopic hernia repair is infection of the mesh. Traditionally mesh infection is managed by surgical removal of the mesh, an extensive procedure resulting in high re-herniation rates. A technique to treat such infections whilst salvaging the mesh is sorely needed. We describe a case in which a laparoscopic mesh infection was treated solely with drainage, parenteral antibiotics and antibiotic irrigation of the mesh.
  
  
  METHODS
  A 65 year old gentleman presented 11 months post laparoscopic repair of an inguinal hernia with malaise and an uncomfortable groin swelling. Computed tomography scanning revealed a collection surrounding the mesh which was drained and cultured to show heavy growth of Staphylococcus aureus. A pigtail drain on continuous drainage was inserted and kept in situ for 7 weeks. The patient received one week of intravenous flucloxacillin and two gentamycin irrigations through the drain as an inpatient. He then received 6 weeks of oral flucloxacillin and bi-weekly saline flushes through the drain in the community. By 12 weeks an ultrasound scan showed resolution of the collection. At 7 months he remains clinically free from recurrence.
  
  
  CONCLUSIONS
  Here we report a novel conservative method used to treat a hernia mesh infection, preserve the mesh and avoid major surgery. Other reports exist suggesting variations in conservative methods to treat mesh infections, however ours is by far the most conservative.
  
  
  CONCLUSIONS
  Clearly, further research is required to identify which method is most effective and in which patients it is likely to be successful.
authors.affiliation: Department of Vascular Surgery, Colchester General Hospital, Turner Road, Colchester CO4 5JL, United Kingdom. Electronic address: dsalston@gmail.com.
authors.forename: Duncan
authors.initials: D
authors.lastname: Alston
authors.forename: Stephanie
authors.initials: S
authors.lastname: Parnell
authors.forename: Bhupinder
authors.initials: B
authors.lastname: Hoonjan
authors.forename: Arun
authors.initials: A
authors.lastname: Sebastian
authors.forename: Adam
authors.initials: A
authors.lastname: Howard
keywords: Hernia; Infection; Irrigation; Laparoscopic; Mesh